With help from Jennifer Haberkorn, Joanne Kenen, Jason Millman and Brett Norman

LIFE IS COMPLICATED AT THE IRS — What do flight attendants, cruise ship workers and temps have in common? They’re all making life complicated for Obamacare bureaucrats at the IRS, Pro’s Kyle Cheney reports. “It’s increasingly clear that the law’s intent — that businesses with 50 or more employees offer health coverage to full-time workers — will only work with exemptions, carve-outs and creative interpretations to accommodate the complexities of the 21st century workforce. Fewer and fewer employees fit neatly into 9-to-5 boxes that clearly delineate who’s full time and who isn’t.” http://politico.pro/1eOVRIJ

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IS BIG FOOD THE NEXT BIG TOBACCO? – Will states start suing the food industry to make it pay for soaring obesity-related costs? Lawyers are pitching the idea to attorneys general in 16 states, Pro Agriculture’s Helena Bottemiller Evich reports. “It’s a move straight from the playbook of the Big Tobacco takedown of the 1990s, which ended in a $246 billion settlement with 46 states, a ban on cigarette marketing to young people and the Food and Drug Administration stepping in to regulate,” she writes. http://politico.pro/1kzMHlG

Good Wednesday morning. Life’s good here at PULSE — Congress is acting semi-functional for once, we’re halfway to a holiday weekend and I’ll be hitting the Colorado slopes in 18 days. SGR — what’s that? Obamacare? Never heard of it. And now for the rest of your midweek tipsheet…

“But I won’t be around for the sentencing, cause I’m PULSE-ing.”

HOUSE PASSES CLEAN DEBT CEILING BILL — It was a long road, but Democrats joined just 28 Republicans last night to pass a bill lifting the debt ceiling until March 2015. Before government funding next runs dry Sept. 30 — and Congress faces its next big fiscal decision — Republican leaders say they’d like to transform their image from the opposition party to the alternative party, in part by passing their own health care reform bill. http://politi.co/1m2nfH7

PROVIDERS PUSHING FOR EXTENDED MEDICAID BOOST — Doctors and hospitals are pushing Congress to extend a temporary ACA program boosting Medicaid pay to doctors — even though there’s barely any evidence that it’s actually attracting more doctors to treat low-income people as intended. The extra payments were delayed for months and they’re scheduled to sunset at the end of this year. Provider groups are trying to build momentum for extending them beyond 2014, but they’re not about to muddy the waters by asking for the proposal to be attached to the SGR repeal plan. http://politico.pro/1iTKWw4

LATINO ENROLLMENT — HHS reports that nearly 4 in 5 uninsured Latinos may qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or subsidized coverage on the exchanges. If all states expanded Medicaid, that would rise to 95 percent. About one in four people eligible for the exchanges are Latino, and they’re concentrated in California, Texas, and Florida. The HHS report: http://1.usa.gov/1kyGzds

--Administration officials also touted improvements to the Spanish-language enrollment website, which didn’t launch until December after weeks of delays. Since then, new features have been added including a window-shopping feature allowing customers to view plan options before buying them, said Mayra Alvarez, associate director of HHS’ Office of Minority Health. She also said they’re trying to reach the Hispanic community with more user-friendly information: “We have found that tech-heavy fact sheets are not very effective for the Latino community. So how do we take advantage of social media and infographics.”

WHITE HOUSE HIGHLIGHTS HEROIN OVERDOSING — Heroin abuse is growing in the U.S. and the White House held a call yesterday to draw attention to the problem. Officials also urged law enforcement around the country to equip first responders with naloxone, a drug that blocks the effects of opiates — including prescription painkillers and heroin — in the brain. While fewer Americans are using heroin casually, the incidence of fatal overdoses has climbed, with about 20,000 people dying annually from some kind of opiate use.

**At Philips, our mission is to create a company that makes a difference to you. We believe the way to achieve this is through innovation — making cities safer and people healthier. Others may focus on what innovation does; we focus on what it does for you. http://philips.to/LQb6EV

STUDY: INSURANCE TAX COSTS STATES UP TO $13.9B – The health care law’s tax on insurance will cost states using Medicaid managed care between $13.3 billion and $13.9 billion over the next decade, according to a new Milliman report commissioned by Medicaid Health Plans of America. Because of matching funds, the feds will tax themselves about $24.1 billion over the same period, Milliman said. That translates to a 1.6 percent increase in Medicaid managed care premiums, but states contracting exclusively with for-profit managed care organizations will see a 2.8 percent increase, according to the report. http://politico.pro/NzLoWw

N.C. PATIENTS EXPOSED TO BRAIN DISEASE — A hospital in Winston-Salem apologized this week after 18 patients were exposed to a rare neurological disease due to improper sterilization. Jeff Lindsay, president of Novant Health Forsyth Medical Center, said the patients may have been exposed to Creutzfeldt-Jakob Disease, a degenerative fatal brain disorder. The AP story: http://bit.ly/LTbguA

PELOSI FOCUSES ON WOMEN — House Minority Leader Nancy Pelosi is trying to make the midterm elections all about women — a demographic Democrats need to win. The party’s agenda is an extension of their “war on women” narrative in recent elections, but now it’s being broadened to include economic issues. http://politico.pro/MJBbWn

FIRST IN PULSE: FORMER SENATORS PUSH FOR HEALTH IT SPACE — A trio of big-name former senators are teaming up to push for an overhaul of regs and laws to make room for a lot more telemedicine and health care technology. It’s a rapidly changing field — but there are lots of barriers to widespread adoption, like difficulties in getting health IT paid for under the fee for service health care system and, generally, under Medicare.

--The former lawmakers are working with “The Alliance for Connected Care” — a mix of insurers, providers and tech companies including Verizon, Healthspot, Wellpoint, CVS, Teladoc, Walgreens, Doctor on Demand, WelchAllyn, MDLive and Care Innovations. They’re kicking it off with a technology demo and discussion at the press club at 8:30 this morning.

STATES STILL LEGISLATING ON SCHOOL IMMUNIZATIONS – State lawmakers introduced a host of bills to help parents opt out of immunization requirements from 2009 to 2012, according to a new paper in the Journal of the American Medical Association. But none of the 31 bills passed — welcome news to advocates of strong immunization programs. Meanwhile, three out of five other bills restricting a so-called “personal belief exemption” from the requirements did pass. http://bit.ly/1iMCjE5

ALTARUM HEALTH INDICATORS — The Altarum Institute has released its latest economic indicators for the health care industry, and they show unusually slow growth in jobs and prices. The sector has gained 2,000 jobs in the last two months — the lowest two-month increase since Altarum began tracking data in 1989. National health care prices in December were 1.1 percent higher than a year before, barely above the all-time low of 1 percent recorded in Oct. 2013. http://bit.ly/1buwRPk

NEW YORK MEDICAID FRAUD — Republican leaders on the House Oversight Committee are urging HHS Secretary Kathleen Sebelius to work toward recovering tens of billions of dollars improperly received by the state through Medicaid overpayments. “New York’s Medicaid program has fostered a system that over the past two decades has wasted vast sums of our nation’s limited resources,” they wrote in a letter. It was signed by Chairman Darrell Issa, along with Reps. James Lankford and Jim Jordan. http://1.usa.gov/1iZn3TO

ACP TO SEBELIUS: WORK ON NARROW NETWORKS — Yesterday, the American College of Physicians released a 21-page report identifying the challenges facing the health law’s implementation and Medicare physician payment reform. The biggest issue, they say, is narrow provider networks. The group called on HHS Secretary Sebelius, the NAIC and insurance trade group AHIP to work on broadening the networks. http://bit.ly/1eSiR8j

FDA TO DISCUSS REGS WITH INDIA — FDA Commissioner Margaret Hamburg has signed a five-year “statement of intent” agreeing to work with India’s public health officials to strengthen regulatory cooperation in relation to medical devices, cosmetics and drugs. Liaisons from both countries will talk in person or over the phone no less than every three months, the statement suggests. http://1.usa.gov/1ctW3aA

WHAT WE’RE READING, By Jason Millman:

The Obama administration will likely extend CGI’s work on HealthCare.gov beyond this month to help with the transition to the website’s new prime contractor, the New York Times reports. http://bit.ly/1m5gTXJ

The latest employer mandate delay may be illegal, but legal experts say it would be tough to challenge in court, Reuters reports. http://reut.rs/1divoBH

Cover Oregon’s enrollment website may finally launch this week, but just for agents and other assisters, the Oregonian reports. http://bit.ly/1nsWJlR

Experts interviewed by USA Today say the ACA is unlikely to “fail” as Republicans have claimed it will. http://usat.ly/1aSwHIg

Former Van Halen great Sammy Hagar and other musicians are pleading with the FDA to allow an experimental treatment for the dying wife of Hagar’s drummer, the Washington Examiner reports. http://washex.am/1cu3ZIS

**At Philips, our mission is to create a company that makes a difference to you. We believe the way to achieve this is through innovation — making cities safer and people healthier. Others may focus on what innovation does; we focus on what it does for you. http://philips.to/LQb6EV

Authors:

About The Author

Paige Winfield Cunningham is a health care reporter for POLITICO Pro and co-author of the morning newsletter Pulse. Previously she reported for The Washington Times’ political team, covering elections, Congress and health policy, including the 2012 Supreme Court ruling on the Affordable Care Act.

Cunningham grew up in St. Louis and attended college in the Chicago area, graduating from Wheaton College in 2006. She spent most of her time at the Wheaton Record, where she served as features editor, but made sure she still had time for playing violin in the conservatory orchestra.

Cunningham covered county government for the Naperville Sun right out of college, but when the paper filed for bankruptcy, she decided it was time to move on. She moved to the D.C. area in 2009 to report on Virginia government and currently lives in that state with her husband.